Posts for: September, 2014
The weapons in the war against cancer are stronger and more effective than ever. But as in real war, those weapons can inflict harm on innocent bystanders — in the case of cancer treatment, other cells in your body. Your mouth in particular may develop side effects from these treatments.
The basic purpose of common cancer treatments like chemotherapy and radiation is to destroy and inhibit future growth of cancer cells. They're very effective to that end, but they can also destroy healthy cells caught in the “crossfire” with malignant cells or have an adverse effect on the body's immune system and its response to infection. Chemotherapy in particular negatively affects blood cells developing within bone marrow, which leads to lower resistance to infection.
These can have secondary effects on the mouth. Patients undergoing cancer treatment can develop painful ulcers and sores within the mouth cavity, and reduced immunity makes them more susceptible to tooth decay or gum disease (especially if risk factors were present before cancer treatment). Certain treatments may also cause dry mouth in some patients.
If you are being treated for cancer, or about to begin treatment, we can help mitigate these effects on your oral health. The first step is to perform a complete dental examination to identify any issues that may affect or be affected by the cancer treatment. We would then treat those conditions (if possible before cancer treatment begins).
We would also monitor your oral health during the treatment period and treat any complications that arise. Such treatments might include applications of high-potency fluoride to strengthen teeth against decay, anti-bacterial rinses to reduce the risk of bacterial growth, and medications to stimulate saliva if you should encounter dry mouth.
Fighting cancer will be your main priority. You should, however, remain aware of how cancer treatment may affect other aspects of your health. As your dentist, we will partner with you in seeing that your teeth and gums remain as healthy as possible during this process.
If you would like more information on caring for oral health during cancer treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Health During Cancer Treatment.”
If you are considering having your teeth straightened, for cosmetic or other reasons, the idea of using clear aligners rather than traditional braces may be appealing.
Here are the answers to some frequently asked questions about clear aligners.
What are clear aligners?
Clear aligners are clear removable custom fitted “trays” that gradually straighten teeth. Used sequentially, each individual tray is slightly different from the one before and is worn every day for two weeks before going on to the next one in the series. This slowly moves your teeth to a new position.
How are they made?
The trays are computer-generated, based on impressions and models of your mouth combined with the knowledge of growth, development of teeth and jaws, and most importantly how and why teeth move.
How long does this treatment take?
By wearing clear aligners for at least 20 hours per day for two weeks before changing to the next tray in the sequence, treatment time can range from six months to two years depending on your individual situation.
Can children wear clear aligners?
Clear aligners are generally used for adults who have all their teeth and when jaw growth is complete, but can be used for younger people depending upon the extent and severity of their situation.
What situations can clear aligners be used for?
Clear aligners can realign or straighten teeth, close mild spaces, treat elongated teeth and tip teeth into better position. They are usually recommended for correcting mild to moderate crowding of teeth, particularly if your back teeth already fit together properly.
When are clear aligners probably not the right choice?
If you have a bad bite (your back teeth do not fit together well), or if you have a severe overbite or underbite, traditional braces are probably a better choice for treatment. If your teeth are severely crowded, or if your situation is complex, clear aligners will probably not be the right treatment choice.
How do you decide whether clear aligners are right for you?
An orthodontic assessment of your individual situation must be performed by our office.
What is considered in the assessment?
The assessment includes specialized x-rays of your teeth, jaws and skull, along with photos, impressions, and models of your bite.
For more information about clear aligners vs. traditional braces, make an appointment with us for a consultation and an examination of your own situation. You can learn more by reading the Dear Doctor magazine article “Clear Orthodontic Aligners: An Alternative for Adult Orthodontics.”
Our “baby” teeth begin appearing around six months of age — by age 10 or 13, they’ve largely been replaced by our permanent teeth. Though their lifespan is relatively short, baby teeth play an important role in our dental development. In fact, saving a damaged baby tooth is an extremely important treatment goal even though they will be eventually lost.
Baby teeth perform a number of functions as our mouth and facial structure develops during our formative years (infancy to early adulthood). Besides providing a means to chew food, baby teeth aid speech by providing contact points for the tongue while speaking. They help us relate to others socially through smiling and other facial gestures. And, in relation to our long-term development, they serve as both guides and “placeholders” for our permanent teeth until they’re ready to erupt.
Thus, a permanent tooth’s development could be stymied if its counterpart baby tooth is lost prematurely. It could come in misaligned or not erupt fully if adjacent teeth have drifted into the open space. The resulting malocclusion (bad bite) could require long-term orthodontic treatment with higher costs than treatments to save the baby tooth and avoid the misalignment.
There are various treatments to prevent and save at-risk baby teeth. Even a badly decayed tooth might be saved with a pulpotomy, a similar treatment to a root canal but less invasive. This is often followed with a stainless steel crown to cover the remaining tooth and restore some of its form and function.
If it’s not feasible to save a baby tooth, we may recommend installing a space maintainer that prevents other teeth from drifting into the resulting space until the permanent tooth is ready to erupt. This orthodontic appliance usually consists of a metal band cemented to an adjacent tooth with an attached stiff wire loop that extends across the gap and rests against the tooth on the other side. Although effective, space maintainers can break or become dislodged, require extra monitoring and are often cosmetically unappealing.
In any event, the primary goal should be to save a baby tooth, if possible. Doing so will prevent more serious long-term problems for permanent teeth.
Your teeth are under constant attack from bacteria that normally live in your mouth. When these bacteria thrive, they create acid that begins to dissolve the minerals in your enamel (the outer layer of your teeth). In your defense, your saliva protects against these bacteria and adds minerals back to your enamel. Let's take a look at this ongoing battle, and what you can do to sway it in a positive direction.
The outer covering of your teeth, the enamel, is made mainly of the minerals calcium and phosphate. The enamel protects the interior layer of your teeth, the dentin, which is similar in composition to bone. Although it is the hardest substance in your body, the enamel is still vulnerable to attack.
Your mouth is normally full of saliva, which washes over your teeth and maintains a balance between acids and bases. The terms “acids” and “bases” refer to a scientific measurement, the pH scale. Your mouth's pH is usually in the middle of the scale — neither acidic nor basic, but neutral. This is important in controlling the bacteria in your mouth.
You may be surprised to know how many bacteria live in everyone's mouth. More bacteria live in a single mouth than the number of people who have ever lived on earth. Some of these bacteria can cause tooth decay. Let's call them “bad bacteria.”
When the bad bacteria attach themselves to dental plaque — a film that builds up on your teeth every day — they begin to consume sugars that are in your mouth from foods that you have eaten. As the bacteria break down these sugars and turn them into energy, acid is produced as a by-product. This turns the saliva from neutral to acidic.
At a certain level of acidity, minerals in your enamel start to dissolve. This is called “de-mineralization.” It means that more calcium and phosphate are leaving the tooth's surface than are entering it. Early de-mineralization of the enamel shows up as white spots on a tooth.
Fortunately, healthy saliva can return calcium and phosphate to the enamel, or re-mineralize it. De-mineralization and opposing re-mineralization are constantly battling in your mouth. However, if too much enamel is de-mineralized, bacterial acid can go on to attack the next layer of your teeth, the dentin. As this process continues, you develop a dental cavity.
How can you protect your teeth? The first level of defense is regular removal of plaque, so that the bad bacteria do not get a foothold. In an office visit we may also recommend products such as sealants, antibacterial agents, topical fluoride, calcium and phosphate supplements, pH neutralizers, special toothpaste and rinses, which may help your particular situation.
Contact us today to schedule an appointment to discuss your questions about tooth decay. You can learn more by reading the Dear Doctor magazine article “Tooth Decay — The World's Oldest & Widespread Disease.”
While dental implants are the preferable choice for teeth replacement, your life circumstances may cause you to postpone it or some other permanent restoration. In the meantime, you need a temporary solution for your tooth loss.
Removable partial dentures (RPDs) have met this need for many years. RPDs are traditionally made of rigid, acrylic plastic resin and fasten to existing teeth with metal clasps. While effective as temporary tooth replacements, RPDs do have their drawbacks: they can be uncomfortable, develop a loose fit and are prone to wear and staining.
Recently, though, new RPDs made of a flexible type of nylon are addressing some of these drawbacks. Because the nylon material is thermoplastic (able to change shape under high heat), it can be injected into a cast mold of a patient’s mouth to create the denture base, to which life-like replacement teeth are then attached. And rather than a metal clasp, these RPDs have thin, finger-like nylon extensions that fit snugly around existing teeth at the gum line.
The new RPDs are lightweight, resistant to fracture and offer a more comfortable, snugger fit than the older RPD. And because the nylon material can be made to closely resemble gum tissue, the base can be designed to cover receding gum tissue, which may further improve the appearance of a patient’s smile.
On the downside, these new RPDs are difficult to reline or repair if they’re damaged or the fit becomes loose. And like all RPDs, they must be regularly removed and cleaned thoroughly to prevent any accumulating bacterial biofilm that could increase the risk of gum disease or tooth decay (the attachment extensions are especially susceptible to this accumulation). They should also be removed at night, since the reduction in saliva flow while you sleep can worsen bacterial buildup.
Still, the new flexible RPD is a good choice to bridge the time gap between lost teeth and a permanent restoration. They can restore lost function and improve your smile during the transition to implants or a fixed bridge.